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Inferior Calcaneal Spur

Heel spur is a thorn-like, bony protrusion of the heel bone, which can become inflamed through irritation, thus causing pain. A heel spur forms at the tendon attachments on the muscles of the heel bone as a result of micro-injuries to the tissue caused by overstraining. As part of the healing process for these micro-injuries, the body stores bone material in the tendon attachments as a repair mechanism. Heel spurs can develop over a very long period without causing major complaints. However, irritation of the area surrounding the ossified tendon attachment can cause inflammations. Left untreated, the inflammations can in turn lead to increased ossification and thus to permanent degradation with a risk of chronic manifestation. The normal rolling procedure that we all use when walking is then frequently no longer possible.

Causes

The cause of heel spurs is excessive strain placed on the plantar fascia over a long period of time, as a result of different factors. These factors include incorrect gait, being overweight, ageing or being in a job that requires a lot of standing on hard floors. It is usually a combination of any of these factors that will bring on the development of heel spurs.

Symptoms

Heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain. Your heel pain may be worse in the morning when you first wake up or during certain activities.

Diagnosis

Diagnosis is made using a few different technologies. X-rays are often used first to ensure there is no fracture or tumor in the region. Then ultrasound is used to check the fascia itself to make sure there is no tear and check the level of scar tissue and damage. Neurosensory testing, a non-painful nerve test, can be used to make sure there is not a local nerve problem if the pain is thought to be nerve related. It is important to remember that one can have a very large heel spur and no plantar fasciitis issues or pain at all, or one can have a great deal of pain and virtually no spur at all.

Non Surgical Treatment

Get some rest. You need to stay off of your aching foot as much as possible for at least a week. Think about possible causes of the problem while you’re resting and figure out how you can make some changes. Some actions that can contribute to heel spurs include running too often or running on hard surfaces such as concrete, tight calf muscles, shoes with poor shock absorption. Ease back into your activities. In many cases, you’ll be in too much pain to go ahead with a strenuous exercise routine that puts pressure or impact on your heel. Listen to your body and switch to different activities such as swimming or riding a bike until your heel spurs improve.

Surgical Treatment

Surgery involves releasing a part of the plantar fascia from its insertion in the heel bone, as well as removing the spur. Many times during the procedure, pinched nerves (neuromas), adding to the pain, are found and removed. Often, an inflamed sac of fluid call an accessory or adventitious bursa is found under the heel spur, and it is removed as well. Postoperative recovery is usually a slipper cast and minimal weight bearing for a period of 3-4 weeks. On some occasions, a removable short-leg walking boot is used or a below knee cast applied.

Prevention

If you have not yet developed this condition, you can take steps to protect yourself from it. Most importantly, make it a rule to wear properly fitted footwear. Avoid shoes that have become worn down in the heel, and don’t choose shoes that cause you to walk in an abnormal fashion. Maintaining a healthy weight will ensure that undue pressure isn’t being put on the ligaments, tendons and bones of your feet. If your job requires a great deal of time on your feet, or if you exercise regularly, be sure to balance periods of activity with periods of rest for your feet.

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Causes

You are more likely to develop plantar fasciitis and heel spurs if you are Active. Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. running, ballet dancing and aerobics. Overweight. Carrying around extra weight increases the strain and stress on your plantar fascia. Pregnant. The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation. On your feet. Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses. Flat Feet or High Foot Arches. Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force. Middle-Aged or Older. With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia. Wearing shoes with poor support. Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury. Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis. Diabetes. Although doctors don’t know why, plantar fasciitis occurs more often in people with diabetes.

Symptoms

Symptoms of heel spur syndrome often include pain early in the morning or after rest, as you take the first few steps. It may also include severe pain after standing or walking long hours, especially on hard cement floors. Usually more pain exist while wearing a very flat soled shoe. A higher heel may actually relieve the pain as an arch is created. The pain is usually sharp, but can also be a dull ache. The pain may only be at the bottom of the heel, or may also travel along the arch of the foot.

Diagnosis

A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

Initially, treatment usually consists of a combination of ice therapy, stretching exercises to improve flexibility (especially in the mornings), anti-inflammatory medications, and physical therapy. Most patients will also need custom-molded orthotics to help control the motion in the foot and arch, which takes the strain off the plantar fascia. If the pain continues, a cortisone injection may be used to calm the severe swelling and pain. There may the need for a night splint to maintain a stretch in the plantar fascia throughout the night.

Surgical Treatment

When chronic heel pain fails to respond to conservative treatment, surgical treatment may be necessary. Heel surgery can provide pain relief and restore mobility. The type of procedure used is based on examination and usually consists of releasing the excessive tightness of the plantar fascia, called a plantar fascia release. The procedure may also include removal of heel spurs.